title: Seeing eye to eye: the key to reducing catheter use.
abstract: OBJECTIVE
  Hemodialysis central venous catheters (CVCs) are increasingly used, despite a prevalence target of <10%. The primary aim of our study was to understand why patients persistently use their CVCs.
  
  
  METHODS
  A multicenter prospective observational study surveyed 322 patients and their vascular access coordinators (VACs) to determine the reasons patients use CVCs. Their responses were compared using multirater kappa statistics. An 18-month follow-up survey was applied to a subgroup of patients consistently using their CVCs, and correlated with the VACs' and patients' previous responses. Predictive associations for specific reasons for CVC use were explored.
  
  
  RESULTS
  Patients indicated "non-medical" reasons (34.8%), having previously failed fistulas/grafts (25.8%), and fear of disfiguration (11.5%) as the main reasons for CVC use. The VAC was in agreement with the patient 16.5% of the time, in partial agreement 37.0%, and in disagreement 46.5%. Twelve percent of patients indicated a desire to change their CVC, yet the VAC was unaware of this 78% of the time.
  
  
  CONCLUSIONS
  The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.
authors.affiliation: University Health Network-Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Maryum
authors.initials: M
authors.lastname: Chaudhry
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bhola
authors.forename: Mohammad
authors.initials: M
authors.lastname: Joarder
authors.forename: Deborah
authors.initials: D
authors.lastname: Zimmerman
authors.forename: Patty
authors.initials: P
authors.lastname: Quinan
authors.forename: David
authors.initials: D
authors.lastname: Mendelssohn
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D055815:Young Adult